5 Possible Health Insurance Claim Rejection Scenarios

Many of us hurry past the terms and conditions section of our Health Insurance. This can lead to grave ignorance regarding the specifics of the policy; spilling disaster in the future. Being cognisant of the negative consequences by reading your Insurance document properly will be useful. 'Ignorance is certainly not bliss', and in this case, it can even result in the rejection of your claim. All details of health insurance plans should be taken with utmost seriousness to facilitate a hassle-free claim process. The adage, 'A stitch in time saves nine' could not be truer and should be heeded at all times. Another aphorism to keep in mind is, 'Prevention is better than cure.' Keeping these proverbs in mind will help you reap dividends in the future. Health Insurance claims get rejected due to a number of reasons. Thoroughly understanding the causes of claim rejection can help you come up with important preventive measures. After all, you are paying premiums and deserve to reap the various benefits provided by your Health Insurance policy.

Reasons for Health Insurance Claim Rejection

1. Exceeding the Sum Insured

There is a term called 'Sum Insured' which many policyholders are unaware of. When you select a health policy, there is an insured sum involved regardless of the type of your plan i.e. individual cover or family floater. Basically, the insured sum is the amount available to customers and their family members (depending upon the plan) every year. If you've availed the total insured amount for a particular year, then all your following cashless Health Insurance claims will get rejected. Nevertheless, if a portion of the sum is intact and your claim is admissible, it will get settled to that extent. Your health policy will not cover many diseases. Hence, knowing what exactly is covered by your health plan is extremely crucial. There will be a section in your policy document, which will clearly list the exclusions - a list of diseases/health conditions for which coverage won't be provided. Going over this section carefully will help you understand your Health Insurance plan better.

2. Misrepresentation of Facts

This is a no-brainer. There should be absolutely no discrepancy between the information declared on the application form and the data provided during the filing of the insurance claim. Any inconsistencies in the provided details can lead to the rejection of your claim. The basis for claim rejections are non-disclosures, providing incomplete information and/or furnishing inaccurate details. Information like your age, income, current Insurance plans, job/occupation details, pre-existing health conditions or major ailments should be accurate.

3. Exceeding the Time Limit

As mentioned in your policy document, claims have to be filed within a certain time frame. If admission to the hospital is pre-planned, you need to update the insurer 2-3 days prior. In case of medical emergencies, claims have to be applied within 24 hours after the patient has been admitted. Failure to apply within the specified time can lead to your claim getting rejected.

4. Not Renewing Your Policy

This goes without saying; it's important to ensure timely health insurance renewal to avail its benefits. Applying for a claim after the expiration of your policy can only lead to rejection. Hence, it's important to note the date of expiry and set reminders accordingly. Consider all the above-mentioned points carefully and exercise caution. By being diligent, you can get the best out of your Health Insurance policy.